Objectives: The purpose of the proposed study is to: 1) measure the increase in Medica home health expenditures resulting from state home health Medicare maximization activities, 2) identify individual and state- level attributes predictive of the transfers to the Medicare program, and 3) determine whether states transfer costs by these activities through increases in the absolute number of home health users as a proportion of the Medicare population, and/or increases in the number of visits per user in the Medicare program Most Medicaid programs deny home health care payment for dual eligibles until Medicare denies the claim for services first. In order to maximize Medicare reimbursement, some states how pay claims for home health care up front and retrospectively pursue Medicare reimbursement, some states now play claims for home health care up front and retrospectively pursue Medicare reimbursement through an appeals process with the Social Security Administration's Administrative Law Judges. Claims appealed include those for post-acute care as well as those for term-term care use for home health care services. As more states are faced with increasing responsibility for providing for the long-term care needs of their citizens, they will face additional pressure to leverage Medicare dollars. Research Methods: The proposed research will measure the amount of home health care costs transferred from the Medicaid to the Medicare program from 1992 to 1997, identify individual and state level attributes predictive of the transfers, and determine the form of the transfers./ Retrospective Medicare maximization activities are expected to lead to higher transfers than prospective activities. The 1992-1997 Cost and Use Files of the Medicare Current Beneficiary Survey (MCBS) will provide a sample of approximately 2,000 observations comprising dual eligibles with home health care use whose expenditures are subject to either retrospective or prospective Medicare maximization activities. The 1992- 1997 Cost and Use Files of the Medicare Current Beneficiary Survey (MCBS) will provide a sample of approximately 2,000 observations comprising dual eligibles with home health care use whose expenditures are subject to either retrospective or prospective Medicare maximization activities. Three separate two-part models with random effects controlling for year effects will use individuals as the unit for analysis for the study. The analyses will control for demographic, health, supply and Medicaid programmatic factors thought to influence home care use. The three outcomes resulting from retrospective state Medicare maximization activities are 1) the increase in Medicare home health care expenditures, 2) the change in the number of home health users per 1,000 Medicare eligibles, and 3) the change in the number of Medicare visits per user. Retrospective Medicare maximization activities result in a change in the source of home health care payment for states and increased access to the Medicare benefit for beneficiaries.